Supplements offer little fracture or fall prevention
In most adults, calcium and vitamin D supplements do not meaningfully prevent fractures or falls.
*Systematic review and meta-analysis of randomized trials; Level 1a.

Citation

Massé O, Mercurio CM, Dupuis S, et al. Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis. BMJ. 2026;393:e088050. doi:10.1136/bmj-2025-088050

Background

Calcium and vitamin D are widely recommended for bone and muscle health, yet past evidence has been inconsistent, especially for falls and for combined supplements. This review updated the evidence from randomized trials and judged whether any benefits are large enough to matter to patients.

Patients

Adults (≥18 years) in 69 trials (153,902 participants), mostly community-dwelling and not at high risk for fractures or falls. Excluded: people receiving drug treatment for osteoporosis; trials focused on osteoporosis drugs, long-term steroid use, or active vitamin D-like drugs.

Intervention

Calcium, vitamin D, or both.

Control

Placebo or no treatment.

Outcome

Primary: any fracture. Secondary: hip, non-spine (non-vertebral), spine (vertebral) fractures; falling; total falls.

Follow-up Period

Median 2.0 years (most trials 1.0–3.2 years).

Results

Outcome (combined calcium + vitamin D vs control) Relative effect Absolute risk difference Number needed to treat
Any fracture (primary) Risk ratio 0.91 (0.84 to 0.99) 1.0% fewer fractures 100
Hip fracture Risk ratio 0.84 (0.74 to 0.96) 0.3% fewer hip fractures 333
Non-spine fracture Risk ratio 0.87 (0.78 to 0.96) 1.6% fewer non-spine fractures 63
Vitamin D alone and calcium alone showed no clear benefit for fractures or falls. The review reported results using an intention-to-treat approach. Although some combined-supplement results were statistically significant, the absolute benefits were small and below the authors’ “clinically meaningful” thresholds.

Limitations

Many included trials had important risk of bias. Most participants were not high risk, and evidence for people in residential care or other high-risk groups was limited for several outcomes. Some control groups may have taken supplements outside the trial, which could hide true differences. Findings do not apply to people taking osteoporosis medicines, who often receive these supplements as background therapy.

Funding

No external funding; a health system paid publication charges.

Clinical Application

Do not recommend routine calcium or vitamin D supplements solely to prevent fractures or falls in average-risk adults; focus on proven fall-prevention and osteoporosis treatments when indicated.